Healthcare Provider Details

I. General information

NPI: 1235142985
Provider Name (Legal Business Name): TERRY D BOX M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N 1900 E 4R118 SOM
SALT LAKE CITY UT
84132-6923
US

IV. Provider business mailing address

1779 MILL LN
SALT LAKE CITY UT
84106-3221
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7804
  • Fax: 801-581-7476
Mailing address:
  • Phone: 801-277-8254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number163791-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number163791-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: